| NPI | 1063573418 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 101912) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301005033) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801066009) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |